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The *Mai Jian Bu Yi* (Supplement to the Meaning of Pulse Simplicity) states that the Ru (Soggy) pulse and Ruo (Weak) pulse are named solely based on their superficial (Fu, floating) and deep (Chen, sunken) positions, and there is no distinction in the diseases they govern. Ultimately, however, there is a distinction; it is merely that previous scholars had not elucidated it! The term "Ru" implies softness, meaning the form is not hard; "Ruo" implies lack of force, meaning the Qi is not strong. Therefore, the Ru pulse indicates Dampness pathogen, while the Ruo pulse indicates Qi deficiency. In cases of limb fatigue, skin swelling, as well as sores, ulcers, tinea, and scabies, the pulse is often Ru. As described by Shi Zaizhi, feeling like pressing into mud indicates Dampness combined with Heat, leaning towards excess pathogen; insufficient respiration, inability to endure labor, spontaneous sweating, night sweats, diarrhea, dysentery, and watery stools indicate the Ruo pulse, caused by Qi decline failing to propel the vessel, leaning towards deficiency of healthy Qi. Dampness can stagnate Qi; when the form is soft, the response to pressure is mostly without force; deficiency generates Cold; when the force is weak, the form is not necessarily always soft. Thus, if the pulse is soft but not weak, it must be due to excessive Heat within Dampness and counterflow of turbid Qi; if the pulse is weak but not soft, it must be due to Cold夹杂 (mixed with) in deficiency, causing the pulse to be tight due to Cold. If both softness and weakness are present, with softness exceeding weakness, it indicates Dampness pathogen has deeply entered the Liver and Spleen, leading to Qi stagnation in the Lung and Stomach, presenting with chest and diaphragm fullness and obstruction, and acid/flaccid flaccidity of limbs; if weakness exceeds softness, it indicates deficiency of True Yang in the Heart and Kidney, and Qi deficiency in the Spleen and Lung, presenting with indigestion, abdominal pain, and frequent loose stools. Yin deficiency injured by Dampness often presents with a deep-soft pulse; Qi deficiency injured by Wind often presents with a superficial-weak pulse. Wind is warm and close to Dryness. If the form is soft and without force, feeling under the fingers like a dead leech, patients with Wind-Damp exterior syndrome can be cured, because this indicates Qi and Blood stagnation and stasis; however, in chronic deficiency and damage, this pulse indicates death, because Qi and Blood have become dull and unresponsive. The form felt under the fingers represents Yin-turbid Qi floating overflowing in the collaterals, remaining undissipated. To treat the Ru pulse, aromatic herbs are primary, assisted by sweet-warm herbs; to treat the Ruo pulse, sweet-warm herbs are primary, assisted by aromatic herbs. If soft but not weak, slightly add bitter-cold herbs; if weak but not soft, further add acrid-warm herbs. This is the general principle.

The Lao (Firm/Deep-Fixed) pulse is a pulse of deep Yin without Yang, indicating Cold-Dampness deeply entering the Liver and Spleen. The physical structure of the Liver and Spleen is filled with blood stasis in its cou-li (interstices), leading to enlargement. Consequently, symptoms include difficulty inhaling, panting upon slight movement, weakness in both calves, stiff and inconvenient lower back, distension in both hypochondria, slight skin swelling, profuse sweating, coarse voice and shortness of breath, and a sensation of obstruction in the throat. These are all caused by the internal and external isolation of Liver-Spleen Qi transformation, due to internal blockage preventing Qi distribution. Recently, I examined four individuals, generally those prone to worry, thought, and depression. One suffered from intense study for the metropolitan examination in Beijing; winter cold penetrated upward from both feet. On the day of Li Chun (Start of Spring), he suddenly felt weakness in his legs; after walking a few paces, he experienced profuse sweating and severe panting. By late summer, he developed flaccidity, wasting, and swelling, with fluids pouring down. Another lived long in damp, low places, exhausting his spirit through business; during spring thunder season, he felt body fatigue and poor appetite; by summer, he lost all desire to eat, his body was heavy, his face pale, he had no sweat below the waist, his body was cold and unwarmed, he panted upon movement, his limbs were soft and his lower back sore, unable to sit for long; by winter he was disabled, and by the following spring could not rise. A third engaged in manual labor and overindulged in sexual activity, allowing Cold-Damp to infiltrate internally; in summer he suffered cough, mistakenly treated with Lung-clearing herbs, leading to hemoptysis from extreme coughing; by autumn he expectorated bloody froth, red as vermilion, his whole body was slightly swollen, he panted upon movement, sweated profusely, his skin was cool and unwarmed. Physicians still treated him as internal heat using clearing and purging methods, and he died on the Autumn Equinox. A fourth was impeached and dismissed from office; he first suffered generalized swelling, shortness of breath, and urgent panting, sitting precariously day and night, unable to lie flat. Treatment temporarily helped, but he still felt coarse voice and floating Qi, weakness in legs; the condition recurred on the Autumn Equinox, and he became incurable. For these four, the pulse was deep, large, and hard. Pressing extremely to the bone, the stronger the pressure, the more forcefully the pulse rebounded against the finger. Even exerting all strength of the arm could not suppress it. Under the fingers, it might be wiry and tight without rapidity, or muddy/turbid with rapidity, or muddy/turbid with slippery and fast qualities, feeling as if dragging countless sticky saliva. Both Cun (inch) pulses were short. At the Guan (bar) positions, initially the left was strong and right weak, later both were strong, or right stronger than left. Sometimes a harmonious/sluggish quality appeared briefly in the middle, but soon returned to Lao, even more severe than before. Bowel movements were not hard but difficult and constipated, exactly as Zhang Zhongjing described: abdominal fullness with hard stool, Cold ascending from below. Tracing the root cause, these individuals generally had robust constitutions but originally turbid Qi and Blood. Added to this was deep infiltration by Dampness. Originally relying on Healthy Qi of the Liver and Spleen for ventilation and dispersal, they exhausted themselves through sexual activity and suppressed themselves through worry/thought. Over time, Liver-Spleen Healthy Qi sank inward, unable to disperse, allowing Cold-Damp to take advantage of the deficiency and stagnate within the Liver-Spleen structures. Blood coagulated in the cou-li, unable to enter or exit, causing the body to become distended and enlarged. Blood coagulation makes it firm; Qi knotting makes it turbid; thus the pulse becomes deep, hidden, firm, and large. How do we know it is Liver-Spleen enlargement? All six Fu organs and five Zang organs have pulses circulating throughout the body. Cold-Damp pathogens transmit internally from vessels to organs. The fine collaterals distributing organ Qi become blocked and cannot drain, causing Qi to concentrate in the larger vessels. The Liver and Spleen govern Blood; their structure is firm and rough, most prone to coagulation. Thus, people with internal blood stasis from fighting or falls often have deep, wiry, large pulses that do not diminish with heavy pressure. Also, in deaths from malaria, Western medicine considers the liver and spleen enlarged, double the normal size. (*Qianjin Yifang*, Vol. 26 end) mentions malaria syndromes where one cannot bend or stretch, eyes bulge, neck feels pulled. Ye Tianshi's *Linzheng Zhinan* also states that malaria with lower back pain and distension is a Liver disease, indicating Traditional Chinese Medicine had this concept early on. Western medicine calls this "Maomu" (Malaria Mass), which is not entirely accurate. Each time I examine advanced-stage malaria syndromes with hypochondriac distension and lower back urgency, the pulse is often deep, large, and wiry, not diminishing with heavy pressure. Moreover, those presenting with this pulse often die in Autumn or Spring, rarely in mid-Winter or mid-Summer. These periods correspond to when the Liver and Spleen are overcome, clearly evident in the pathology. When symptoms are mild and not yet severe, urgently use aromatic, ventilating formulas to disperse and transform Cold-Damp, soothe the Liver and awaken the Spleen, assisted by bitter-descending and bland-leaching methods, so that Cold ascending from below may exit from below; add blood-invigorating and collateral-unblocking agents to gradually open the cou-li obstructions, potentially saving one or two lives. Potent drugs taken urgently cannot be achieved by mild, slackening methods.